ALTCS vs. private pay: what changes when you qualify

Many families start out paying privately for assisted living and expect that, at some point, savings will run low and ALTCS will take over. Others are applying for ALTCS now and wondering what life looks like once it is approved. Either way, it helps to know what actually changes: what you pay, where your loved one can live, and what to sort out before signing a contract. This guide compares the two, step by step. For how ALTCS works and who may qualify, start with our ALTCS guide.

Good to know: AHCCCS decides who qualifies for ALTCS and calculates what each person owes. Program rules and figures change, and how they apply depends on your family’s situation. Check current details with AHCCCS, and talk to an elder law attorney before moving, selling or giving away assets.

What private pay looks like

When you pay privately, the community or care home charges a monthly rate, and you pay it from income, savings, the sale of a home, long-term care insurance or a mix of these. The rate usually covers the room, meals and a level of care, with extra charges as needs increase.

Private pay gives you the widest choice. Any place with an opening that can meet your loved one’s needs is an option, and you can usually move in as soon as the community’s assessment and paperwork are done.

The trade-off is cost. Assisted living and memory care are expensive, and needs tend to grow over time, so the monthly bill often rises. That is why it is worth thinking about ALTCS early, even if you don’t expect to need it for a while.

What changes under ALTCS

Once ALTCS is approved, the money works differently. In assisted living, ALTCS generally pays for the care, not the room and board.

• Room and board (rent and meals) is still the resident’s responsibility, usually paid from their own income, such as Social Security or a pension.
• Share of cost may also apply. Depending on income, AHCCCS may require the resident to pay part of the cost of their care each month.
• Personal needs. Rules generally allow the resident to keep a small amount of income for personal needs. AHCCCS sets the figure.

So the family’s bill usually gets smaller, but it rarely drops to nothing. When you compare places, ask for the monthly cost under ALTCS in writing, broken into room and board, any share of cost, and anything the community charges that ALTCS doesn’t cover.

Your choice of places

This is the change that surprises families most. Not every assisted living community or care home accepts ALTCS, and those that do may only have a limited number of ALTCS spaces.

Under private pay you might be choosing between many places. Under ALTCS, the list is usually shorter, and the right place may have a waiting list. Location, room type and amenities may also be more limited.

None of this means ALTCS options are poor. Many good residential care homes and communities accept ALTCS. It means the search works best when you know the payment situation from the start, so you aren’t touring places that could never be a long-term home.

Moving from private pay to ALTCS mid-stay

Many families plan to pay privately for a while and switch to ALTCS later. That can work well, but only if the community allows it. Some places accept residents who convert to ALTCS. Others require private pay for a set period first, and some don’t accept ALTCS at all, which can mean a second move just when your loved one has settled in.

Before you sign anything, ask:

• Do you accept ALTCS, and do you have ALTCS spaces?
• If my loved one starts as private pay, can they stay when ALTCS is approved?
• Is there a minimum private-pay period before converting?
• Would the room, the care or the monthly cost to the family change after the switch?

Get the answers in writing. A move later in life is hard on anyone, and especially hard on someone living with dementia.

How long it takes

An ALTCS application takes time. There is paperwork to gather, a medical assessment called the PAS, and a review of income and assets, including gifts and transfers made in the years before the application. Missing documents are one of the most common reasons for delay.

If a move can’t wait, many families pay privately while the application is pending. Ask the community how it handles residents whose application is in progress, and keep copies of everything you send to AHCCCS.

Common questions

Will ALTCS pay for everything once it is approved?

Usually not. In assisted living, ALTCS generally covers care, while the resident pays room and board and may owe a share of cost. Ask each place what the family would pay each month under ALTCS.

Can my loved one stay in the same place after switching to ALTCS?

Only if that community accepts ALTCS and agrees to it. Ask before you sign, and get the answer in writing.

Should we spend down savings to qualify faster?

Don’t make that decision alone. How money is spent, and when, can affect eligibility, including the look-back on gifts and transfers. Talk to an elder law attorney first.

Does ALTCS cover memory care?

ALTCS can pay for care in settings licensed for the level of care someone needs, including some memory care. Availability of ALTCS spaces in memory care can be limited, so ask early.

How we can help

We can tell you which communities and care homes on your shortlist accept ALTCS, whether they have space, and how they handle residents who switch from private pay, so you can choose a place your loved one won’t have to leave. Whether you are looking for assisted living in the Phoenix area or a residential care home, we look anywhere in the Valley. We don’t complete ALTCS applications or give legal or financial advice, but we can point you toward people who do. Talk to us about where things stand.